PHILADELPHIA — A doctor accused of running a filthy “abortion mill” for decades in an impoverished Philadelphia neighborhood delivered babies alive, killed them with scissors and allowed a woman who had survived 20 years in a refugee camp to be overmedicated and die at his clinic, prosecutors said.

Dr. Kermit Gosnell, 69, was charged Wednesday with eight counts of murder for the deaths of seven babies and one patient. Nine employees also were charged, including four with murder.

Prosecutors described the clinic as a “house of horrors” where Gosnell kept baby body parts on the shelves, allowed a 15-year-old high school student to perform intravenous anesthesia on patients and had his licensed cosmetologist wife do late-term abortions. A family practice physician, Gosnell has no certification in gynecology or obstetrics.

Four months after Karnamaya Mongar reached the United States after spending nearly two decades in camps in Nepal she was dead at Gosnell’s clinic. The 41-year-old mother of three died of cardiac arrest when she was given too much Demerol and other drugs, prosecutors said.

“Pennsylvania is not a third-world country. There were several oversight agencies that stumbled upon and should have shut down Kermit Gosnell long ago. But none of them did, even after Karnamaya Mongar’s death,” city prosecutors charged in a nearly 300-page grand jury report.

The “Women’s Medical Society” opened in 1979 and was inspected by the state Department of Health only sporadically. The last inspection was in 1993. Philadelphia District Attorney Seth Williams accused state health officials of “utter disregard” for Gosnell’s patients, who were mostly poor minority women like Mongar.

Gosnell made millions performing thousands of dangerous abortions. A second woman, a 22-year-old mother of two from Philadelphia, died in 2000 from a perforated uterus.

Mongar, a refugee with her husband Ash from native Bhutan, had gone to the clinic in November 2009. Gosnell wasn’t at the clinic at the time. His staff administered the drugs repeatedly to the 4-foot-11, 110-pound Mongar as they waited for him to arrive. No one who answered the phone Wednesday at a listing for Ash Mongar in Virginia could comment.

“Those are the kind of stories that break your heart,” said Vicki Saporta, president of the National Abortion Federation, which rejected Gosnell from membership years ago because he did not meet its standards of care. The group’s 400 members perform about half the abortions in North America, she said.

“Unfortunately, some women don’t know where to turn. You sometimes have substandard providers preying on low-income women who don’t know that they do have other (safe) options,” she said.

Authorities who raided Gosnell’s clinic early last year in search of controlled drug violations instead stumbled upon a stench-filled clinic with bags and bottles of aborted fetuses scattered throughout the building.

“By day it was a prescription mill; by night it was an abortion mill,” the grand jury report said.

Oddly, Gosnell also kept jars of severed feet on his shelves, Williams said. Gosnell also had a taste for macabre jokes, once muttering that a nearly six-pound baby born alive to a 17-year-old who was seven-and-a-half months pregnant could “walk me to the bus stop,” the report said.

Gosnell typically worked weeknights, arriving hours after his unskilled staff administered anesthesia and drugs to induce labor. He then “forced the live birth of viable babies in the sixth, seventh, eighth month of pregnancy and then killed those babies by cutting into the back of the neck with scissors and severing their spinal cord,” Williams said.

In addition to the two women who died, scores more were injured from perforated bowels, cervixes and uteruses, authorities said. Some were left sterile at the clinic, which had no trained nurses or medical staff other than Gosnell, they said.

“He does not know how to do an abortion,” Assistant District Attorney Joanne Pescatore said. “Once he got them there, he saw dollar signs and did abortions that other people wouldn’t do.”

Women came from across the city, state and mid-Atlantic region for the illegal late-term abortions, authorities said. He didn’t advertise, but word got around. They paid $325 for first-trimester abortions and $1,600 to $3,000 for abortions up to 30 weeks. The clinic took in up to $15,000 a day, authorities said.

“People knew near and far that if you needed a late-term abortion you could go see Dr. Gosnell,” Williams said.

White women from the suburbs were ushered into a separate, slightly cleaner area because Gosnell believed they were more likely to file complaints, Williams said.

Few if any of the unconscious patients knew their babies had been born alive and then killed, prosecutors said. Many were first-time mothers who were told they were 24 weeks pregnant, even if they were much further along, authorities said.

State regulators ignored complaints about Gosnell, or the 46 lawsuits filed against him. State officials, who arrived to testify with lawyers in tow, “enraged” the grand jury, Williams said. Yet he could find no criminal charges with which to charge them, in part because of the time that had elapsed.

The state’s reluctance to investigate, under several administrations, may stem partly from the sensitivity of the abortion debate, Williams said. Nonetheless, he called Gosnell’s case a clear case of murder.

“A doctor who with scissors cuts into the necks, severing the spinal cords of living, breathing babies who would survive with proper medical attention commits murder under the law,” he said. “Regardless of one’s feelings about abortion, whatever one’s beliefs, that is the law.”

The grand jury spent a year investigating Gosnell’s practice. According to the report, Gosnell had no nurses on hand to monitor the women’s medication or recovery, no hospital on standby for emergencies and few if any medical records because Gosnell destroyed them. His staff testified about “scores of gruesome killings” of infants born alive.

“These killings became so routine that no one could put an exact number on them,” the grand jury report said. “They were considered ‘standard procedure.'”

Authorities charged that Gosnell deliberately hired unqualified staff so he could pay them low wages. He sent his six children to private schools – one is now a doctor and another a professor – and has a beach house at the New Jersey shore, prosecutors said.

Besides the five charged with murder, five other clinic employees, including Gosnell’s wife, were charged with conspiracy, drug and other crimes. Pearl Gosnell, the doctor’s third wife, performed extremely late-term abortions on Sundays when the clinic was otherwise closed, the report said. All 10 charged were in custody.

Williams, a Democrat, released the report a day after Republican Gov. Tom Corbett succeeded Gov. Ed Rendell, a Democrat. Spokesman Kevin Harley pledged Corbett’s administration would do more to oversee such clinics.

Lawyer William J. Brennan, who represented Gosnell during the investigation, noted that the doctor served patients in a low-income city neighborhood for decades.

“Obviously, these allegations are very, very serious,” Brennan said.

Under Pennsylvania law, abortions are illegal after 24 weeks of pregnancy, or just under six months, and most doctors won’t perform them after 20 weeks because of the risks, prosecutors said.

In a typical late-term abortion, the fetus is dismembered in the uterus and then removed in pieces. That is more common than the procedure opponents call “partial-birth abortion,” in which the fetus is partially extracted before being destroyed.

Gosnell earned his medical degree from Thomas Jefferson University in Philadelphia and is board certified in family practice. He started, but did not finish, a residency in obstetrics-gynecology, authorities said.